Self as context involves experiencing oneself as the place, perspective, or context in which private events occur, as opposed to the “conceptualized self” where oneself is expe- rienced as being these private events (e.g., self-judgments). Self as context is essential to understanding the distinction between one’s experiences and the person experiencing or being aware of these experiences. Self as context is assuming increasing importance in ACT work with children because of the evidence reviewed earlier relating deictic frames to perspective taking, theory of mind, and empathy skills. Self as context is also a useful process to address when a child is attached to a conceptualization of himself or herself that is problematic. For example, a child may see himself as the “bully” or herself as the “class goofball” and only behave in ways that support that conceptualization of self.
For some externalizing disorders, such as conduct disorder, there may be clini- cal benefits to the child being able to take the perspective of his or her peers. Some behavioral deficits are not in particular overt responses but rather are in one’s ability to respond relationally, which is a higher-order “cognitive” deficit. The relational abili- ties necessary to take another’s perspective can be modified through “deictic relations,” such as I-you, here-there, and now-then. If a child has these relational abilities, then he will be better able to respond from another’s perspective, thus showing greater empathy and social sensitivity. Technologies from RFT have been shown to be useful in training these abilities. The procedures necessary to train these relational frames are generally straightforward: the relational operant needs to be trained across many contexts, with many stimuli, and the operant should not be based off of formal features of the stimuli— thus making it generalizable. For example, the deictic frame I-you should be trained across many different people where the “I” stays constant and the “you” changes. After training this relation across many different people, the client learns that the “you” is not formally defined in an absolute sense but is based on arbitrary contexts.
The client can also be trained to apply the deictic frame “I-you” to other people having a conversation. After multiple exemplars, the client learns that “I” is context dependent and does not always refer to the client. To increase generalization, this frame can also be applied to other animals such as cats or dogs or to pictures of people. Similarly, the flexibility of deictic frames should be targeted (e.g., “if here were there and there were here, what would be here?”). Empirical support for this type of work exists (Heagle & Rehfeldt, 2006; Weil, 2007). Similarly, it has been proposed that deficits in relational abilities also play a part in ADHD (Twohig, et al., in press). For example, children with ADHD may lack the relational abilities necessary to “understand” a self-control task. Specifically, relational frames of coordination, temporal (time or contingency), and com- parison are necessary to understand and follow a rule. Similar training procedures would be used to train these types of relational responding abilities in children with ADHD.
The second way that self as context can be useful when treating childhood conduct disorders is when there is a behavioral excess of seeing one’s private events as represen- tations of themselves. It can be difficult for a child to let go of a particular thought or feeling when that child sees that private event as a part of who she is. It might be hard on the child’s “pride” to be told what to do by the teacher if that child sees her pride and herself as the same thing. Thus a context where it is safe to experience such feelings and thoughts needs to be created. This constant sense of being in the present as a whole person that can’t be damaged sets the context where “dangerous” thoughts and feelings can be safely experienced. This is evidenced by the way that many children speak of their thoughts and feelings, such as “I am angry” or “I just have too much energy,” as though the person and these feelings are linked in such a way that the feelings have power over the child’s behavior. Self as context helps the child experience thoughts and feelings as events that occur within the individual but do not define the individual— they are events that come and go just as all other events in life. They are not more important or less important than other events throughout the day. The child is not defined by these thoughts or feelings; they are part of the whole. The child is taught to experience these events in different ways. This helps the client experience events with less evaluation and more as they really are. This practice shares some similarities to mindfulness and meditation practices, but only in the way that these skills teach the child to experience thoughts as thoughts and feelings as feelings, not as defining characteristics of her as a person.
Self as context training to date has focused on the flexibility of deictic frames (e.g., “If I were you, what would I be seeing?”), but it is easy to extend the concept in other frames. For example, a clinician might ask the child to describe a number of different qualities of the therapist, assuring the client she can say whatever she wants. The client will likely say things such as male/female, old/young, rich/poor, smart/dumb, funny/boring, nice/mean, and so on. The therapist can help the child recognize which qualities are more stable and concrete, such as male/female, and which are arguable, such as funny/boring and nice/mean. Next, the therapist can ask the child to come up with similar characteristics for herself. The child will likely come up with similar quali- ties such as young, good at sports, funny, smart, popular, girl, and so on. Together the
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therapist and child can note the identities that they do not have to work hard to keep, such as male/female and age, and contrast these with the ones that they struggle with, such as “smart” or “popular.” The clinician should help the child talk about the things that she does to support the self concepts of “smart” and “popular”—or whatever it is for the child.
At this point, it may be useful to engage in flexibility training around the change- able concepts. The clinician might role-play with the child how he might act if each of these features were changed in either a positive or negative way. With negative self- concepts in particular, they can explore ways in which the child does in fact act that contradict this concept at times. The point is to show how fluid self-concept behaviors can be, even though they tend to be “sticky” conceptually. We suggest returning to key concepts that are especially troublesome to the youth (e.g., tough guy, bad son, stupid) and explore with the child how he will still be himself even without those particular concepts. He will still have the thousands of other properties of value if he lets certain ones go. After all, these concepts are not him in the same way that he is male.
Values
There are many things that are important to children: family, sports, friends, school, and so on. Values in ACT are areas of life that one cares about. They are different from goals. Goals are generally temporary events that have a final outcome, whereas values are elements of life that are important to the person and that he or she is willing to work on. This is the part of therapy that adds meaning to the processes that were previ- ously attended to, such as experiencing difficult emotions and thoughts. In turn, linking these previous ACT processes up to valued actions can alter their function. This is the only area in ACT where specific relations are targeted. In all other processes, there is great caution in altering cognitions directly. This is an area where being literal is less problematic. For example, a child diagnosed with ADHD may value being in school and being part of a class, but acting on his urges to get out his seat and yell out in class is interfering with his values. Reminding the child of how attempts at controlling emo- tions may take him away from his values can make it more rewarding to experience the emotions rather than try to control them. The therapist might say to the child, “Staying in your chair all the way through class and only talking when the teacher calls on you would make you more part of your class and would allow you to attend all recesses.” It changes the function of the urges to get out of the chair from feelings that get in the way to opportunities for doing things that are important to the child.
In some instances, a child will not be able to specify or come into contact with larger values. This is not an issue, because each child is at a different place developmen- tally. Because values work is functional, it can still be done and is of use to therapists. The client may not be able to specify larger values, but he or she will likely value par- ticipating in recess or not having detention. Clarifying these relationships can be just as useful as clarifying the relationship between acceptance and larger processes. There will be a time later in therapy when the client can work on specifying larger values. When
working on values clarification with youth, it can help to describe “valuing” as moving in chosen directions in life. The therapist and child might work together to create a “values compass” in which the child’s values are written in an area representing his or her chosen life directions. For example, a recent client reported that he cared most about family and friends. He said that getting in trouble at school hurts his relation- ship with his mother, and that yelling and being aggressive hurts his friendships. Being helpful at home, not fighting and yelling, and staying out of trouble at school results in a better relationship with his mother. Similarly, not yelling and being more patient results in better relationships with his friends. A list of values-consistent behaviors such as helping at home and doing well in school was easily created in conjunction with a list of values-inconsistent behaviors such as fighting and yelling. When asked to think of internal barriers to following his values, the child noted that he engages in values- inconsistent behaviors when he feels angry. He was assisted in seeing that fighting and yelling were often attempts to control the feeling of anger, and acceptance was offered as an alternative.
When working with children who are a little older, such as in their teenage years, they can be asked to imagine their high school graduation. Clients can be asked to close their eyes and to imagine two outcomes for their high school graduation—the first based on how they are living their lives right now, and the second based on a world where anything is possible and they are able to choose the graduation they really want. Children can also talk about the qualities of the people they look up to and ways that they want to be more like them. For example, a child may look up to her parent or a famous athlete. The therapist might ask the child to describe those qualities of the parent that she looks up to and then help the child see how those attributes can be pursued in her own life.